Substance abuse in Pregnancy

Question 1

What is the most dangerous of the common substances used as exposed fetuses generally have serious, permanent impairment?

Answer 1

Alcohol

Question 2

what is the most common cause of low birth weight in infants and has also been shown to have behavior problems in prenatally exposed children ?

Answer 2

tobacco use

Question 3

Children of mothers who use drugs during pregnancy are at higher risk for __________

Answer 3

physical, emotional and sexual abuse

Question 4

abuse of both legal and illegal substances is more common among mothers in ___________ however abuse occurs across all______

Answer 4

Lower socioeconomic groups

all socioeconomic groups

Question 5

When to consider drug abuse during pregnancy~

Physical evidence of IV drug use

Answer 5

track marks, nasal hyperemia, septal defects

Question 6

When to consider drug abuse during pregnancy~

High risk historical or social factors

Answer 6

no prenatal care
denial of pregnancy
family hx of drugs
previous child abuse or neglect
lack of support system
psychiatric problems
hx of legal problems

Question 7

What obstetric complications would lead you to consider drug abuse during pregnancy~

Answer 7

• placental abruption
• unexplained preterm labor
• uterine trauma/abuse
• IUGR
• previous poor birth outcome

Question 8

Maternal complications from substance abuse~ neurological

Answer 8

cocaine= seizures, postpartum intracerebral hemorrhage
amphetamines, LSD= psychosis
heroin= abstinence syndrome, mononeuritis, polyneuritis, transverse myelitis

Question 9

Maternal complications from substance abuse~ cardiovascular

Answer 9

cocaine, amphetamines=htn, infarction, cardiomyopathy, arrhythmias, sudden death
IV drug use= bacterial endocarditis

Question 10

maternal complications from substance abuse~ infectious

Answer 10

IV drugs= Hep B & C, HIV, cellulitis

All drugs= PNA, UTI, STI

Question 11

maternal complications from substance abuse ~ GI

Answer 11

Cocaine= intestinal infarction

IV drug use= acute and chronic hepatitis

Question 12

________can be a maternal complication from substance abuse

Answer 12

poor nutrition

Question 13

Obtaining the substance abuse history

Answer 13

obtain verbally~ no questionnaires
obtain in a private setting away from friends and family
nonjudgmental attitude~ primary interest is child’s welfare not punishing mom
be direct
ask about drug abuse in household members
if admission of drug abuse, ask about dose, routes and duration of use

Question 14

Hospitals are _______from testing women for illegal drug use without their consent and then reporting positive test results to law enforcement

Answer 14

prohibited

Question 15

if a neonate presents with unexplained neurological symptoms, a drug test_______without parental consent

Answer 15

Can be done

Question 16

Urine toxicology time periods for positive test after last use:

Answer 16

Alcohol~ hours
amphetamines and cocaine~ 1-3 days
opiates~ 2-4 days 
LSD~ 2-3 days 
Marijuana~ 7-30 days

Question 17

urine tests for narcotics are ______ at the time the neonate develops symptoms of withdrawal

Answer 17

negative

Question 18

meconium and hair screening can be used to detect drug abuse during the _______

Answer 18

second half of pregnancy

*collect meconium sample from first 48 hrs of life

Question 19

Cocaine (crack) exposure

Answer 19

• what it is = a local anesthetic and CNS stimulant
• believed to be a teratogen and crosses the placenta
• there is no clinically documented withdrawal syndrome from cocaine
• abnormalities in infants exposed to cocaine reflect continued drug effects

Question 20

S/S of cocaine abuse

Answer 20

premature labor, placental abruption, fetal asphyxia

(many infants show no S/S of affects of cocaine

Question 21

Cocaine exposure findings may include

Answer 21

LBW
IUGR
prematurity
fetal distress and meconium staining
microcephaly
anomalies of urinary or GI tracts
feeding difficulties
irritability
abnormal sleep patterns 
hypertonia

Question 22

Neurobehavioral findings of infants exposed to cocaine in utero tend to present on what days?

Answer 22

days 2-3

Question 23

Management of cocaine exposed neonate

Answer 23

use the “S’s “
offer quiet environment
because cocaine is detectable in breastmilk, mothers who have used cocaine recently should not breast-feed
involve child/family services
higher rates of STI’s in women who use cociane ~ consider testing

Question 24

perinatal cocaine exposure~ long term

Answer 24

changes in IQ or behavior
neurobehavioral dysfunction
hyperactivity
aggression 
short term attention span problems